Sunitinib (Sutent ®)
Sunitinib (Sutent ®) may be used to treat a type of kidney cancer called renal cell carcinoma (RCC), gastrointestinal stromal tumours (GISTs) and a rare type of pancreatic cancer called a neuroendocrine tumour.
Sunitinib may be used to treat other types of cancer as part of a research trial.
Sunitinib is a type of treatment called a multi-kinase inhibitor. Kinases are important proteins in the body that regulate how the cells grow and divide.
Sunitinib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide. Blocking the signals causes the cells to die.
Sunitinib can also stop cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients, which causes the tumour to shrink or stop growing. Drugs that interfere with blood vessel growth in this way are called angiogenesis inhibitors or anti-angiogenics.
When sunitinib is used
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Sunitinib is licensed to treat various types of cancer.
The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland.
If sunitinib is not recommended for you it may not be available on the NHS, although you may be given it as part of a clinical trial. We can give you more information on what you can do if a treatment isn’t available.
Sunitinib is licensed to treat people with kidney cancer that has spread outside the kidney (advanced or metastatic renal cell carcinoma).
NICE has recommended sunitinib as a possible first drug treatment for some people with advanced renal cell carcinoma. However, the SMC have not recommended its use in this situation.
Gastrointestinal stromal tumours (GISTs)
Sunitinib is also licensed for people with gastrointestinal stromal tumours (GISTs) that can’t be removed with surgery (are unresectable) or have spread (are advanced/metastatic), and are no longer helped by the drug imatinib (Glivec ®).
NICE and the SMC have both recommended sunitinib as a possible treatment for people with an unresectable and/or advanced GIST that is no longer responding to the drug imatinib. It can also be given where the GIST is causing too many side effects.
Sunitinib is also licensed to treat people with pancreatic neuroendocrine tumours (pancreatic NETs) that can’t be removed with surgery or have spread beyond the pancreas.
The SMC has recommended sunitinib as a possible treatment for people with an unresectable and/or advanced pancreatic NET.
What sunitinib looks like
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Sunitinib is an orange/caramel coloured capsule. It comes in four strengths: 12.5mg, 25mg, 37.5mg and 50mg.
How sunitinab is taken
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Sunitinib is taken with a glass of water and can be taken with or without food. It should not be taken with grapefruit or grapefruit juice.
Your doctor will tell you what dose of sunitinib you'll need to take. When given to treat renal cancer or GIST, the usual dose is 50mg once a day for four weeks, followed by two weeks without the drug. This makes up a cycle of treatment that lasts for six weeks.
When given to treat pancreatic neuroendocrine tumours (pancreatic NETs), sunitinib is usually given at a dose of 37.5mg and is taken once a day.
Your doctor will tell you which dose you have to take.
Possible side effects of sunitinib
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Feeling tired is a common side effect, especially towards the end of treatment and for some weeks after treatment is over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Hand-foot skin reaction
You may notice redness on the palms of your hands and soles of your feet. Sometimes the hands and feet become sore or swollen. There may also be changes in sensation, such as numbness or tingling. If you have symptoms, let your specialist know. Keeping your hands and feet cool, avoiding hot water and using a non-perfumed moisturiser may also help.
Occasionally, if soreness doesn’t settle or if blistering develops, your doctors may need to reduce the dose of sunitinib or interrupt the treatment. Very rarely, treatment may need to be stopped.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Some people find sucking on ice soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening.
Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to help.
Effects on the hair and skin
Hair and skin colour can be affected by sunitinib. Your hair may lose colour or become thinner. Hair thinning is temporary. Your skin may lose colour and become yellowish. Other changes to the skin may include a rash, redness, dryness or itching. Speak to your doctor or nurse if you have any of these symptoms.
High blood pressure
Sunitinib can cause high blood pressure in some people. This is most likely to happen within the first few weeks of taking sunitinib. If you develop high blood pressure, your treatment may be interrupted or you may be prescribed medicine to control your blood pressure.
You may have frequent or loose bowel movements. This can usually be easily controlled with medicine, but you should tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Feeling sick (nausea)
This is usually mild. If you do feel sick, it may begin a few hours after treatment and last for a few days. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting.
If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Sunitinib may make your thyroid work less effectively. Symptoms of an underactive thyroid include tiredness, weight gain, constipation, aches, feeling cold, dry skin and dry hair. If you have any new symptoms, let your doctor know. You may need a blood test to check your thyroid levels.
This drug may cause bleeding, most often from the nose (nosebleeds). You should contact your doctor straight away if you notice any unexplained bleeding such as bleeding gums, bleeding from your back passage or blood in your stools. They will advise you about this and any precautions you should take.
Sunitinib may cause heart problems, although this is rare. If you have chest pain or breathlessness, it may mean that your heart is affected and you should contact your doctor immediately.
Sunitinib may increase your chance of getting a blood clot. If you become breathless or get pain in your limbs, tell your doctor straight away.
Slow wound healing
Wounds may take longer to heal while you're having treatment with sunitinib. If you have any surgery planned you may need to stop taking sunitinib before the operation and not start taking it again for a few weeks afterwards. Your doctor will give you more advice.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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You should avoid taking the herbal remedy St John’s Wort while having sunitinib. Some other medicines, including those that you can buy in a shop or chemist, can be harmful to take when you’re having sunitinib. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Little is known about the effects of sunitinib on a developing baby. Therefore, it is not advisable to become pregnant or father a child while taking this drug.
It’s not known whether sunitinib is present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that sunitinib may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having sunitinib treatment. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours, you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
Things to remember about sunitinib tablets
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It’s important to take your tablets at the right times, as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you are taking a course of sunitinib tablets, which should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in the original packaging and store them at room temperature.
Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the tablets, let your doctor know. You may need to take another dose. Don't take another tablet without telling your doctor, nurse or pharmacist first.
If you forget to take a tablet, don't take a double dose. Tell your doctor and keep to your regular dose schedule.
This information has been compiled using information from a number of reliable sources, including:
British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
National Institute of Health and Clinical Excellence (NICE). Sunitinib for the first-line treatment of advanced and/or metastatic renal cell carcinoma (TA169). March 2009. National Institute of Health and Clinical Excellence (NICE).
National Institute of Health and Clinical Excellence (NICE). Sunitinib for the treatment of gastrointestinal stromal tumours (TA179). September 2009. National Institute of Health and Clinical Excellence (NICE).
Scottish Medicines Consortium (SMC). Advice on 698/11 – Sunitinib (Sutent). May 2011. Scottish Medicines Consortium (SMC).
Scottish Medicines Consortium (SMC). Advice on 275/06 – Sunitinib (Sutent). November 2009. Scottish Medicines Consortium (SMC).
Scottish Medicines Consortium (SMC). Advice on 384/07 – Sunitinib 12.5mg, 25mg and 50mg capsules (Sutent). July 2007. Scottish Medicines Consortium (SMC).
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2012).
With thanks to Dr James Larkin, Consultant Oncologist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when join our Cancer Voices network.